Nominee Slip Hurts Health Care Drive

WASHINGTON — The abrupt collapse of Tom Daschle’s cabinet nomination on Tuesday undercut President Obama’s mission to expand health care by depriving him of an unusually well positioned architect for a big legislative campaign and leaving him without a backup plan.

Mr. Daschle’s decision to withdraw his candidacy for secretary of health and human services could slow the president’s drive to reshape the nation’s health care system as the White House searches for a replacement, and it could allow Congress to step into the vacuum during that delay, analysts said.

But the White House insisted that Mr. Daschle’s departure would not stop the effort to cover the uninsured and rein in health costs, a goal that is “bigger than one person,” as the press secretary, Robert Gibbs, put it. “We’re looking for a new nominee,” Mr. Gibbs said, “but the problem has existed for quite some time, and the work toward a solution to make health care more affordable won’t stop or won’t pause while we look for that nominee.”

Since Mr. Daschle was the only person the president seriously considered for the health job, his advisers were left scrambling to find an alternative. Advocates of universal coverage pressed the case for former Gov. Howard Dean of Vermont, a medical doctor, but Mr. Obama just replaced him as chairman of the Democratic National Committee and he might be a provocative choice to Republicans.

Democrats close to the White House said attention was focusing on governors, who by nature of their jobs run state Medicaid programs, particularly Gov. Kathleen Sebelius of Kansas. Other possibilities include Govs. Edward G. Rendell of Pennsylvania and Jennifer M. Granholm of Michigan and former Gov. John Kitzhaber of Oregon, all Democrats. Ms. Sebelius was an early supporter of Mr. Obama’s campaign while Mr. Rendell and Ms. Granholm joined after the primaries. Mr. Kitzhaber is a former emergency room physician who pushed through health care changes while in office.

David Axelrod, the president’s senior adviser, said the White House would “quickly put someone in place” but acknowledged it had no stand-in ready for Mr. Daschle, a former Senate majority leader and a co-author of a book on health care. “There was no Plan B,” Mr. Axelrod said. “Our intent was that he would serve. But there’s a wellspring of talent and particularly people who are interested in this issue.”

The White House is considering replacing Mr. Daschle with two people. Mr. Daschle had negotiated a special arrangement to serve in the cabinet while also serving as director of a new White House Office of Health Reform, empowering him to pull together the disparate elements of government.

Instead, Mr. Obama’s advisers said the president might appoint someone other than the next secretary to lead the White House office, possibly Jeanne M. Lambrew, Mr. Daschle’s co-author, who had already started working as the office’s deputy director. If the president elevated her, she could push forward with policy development even while a new nominee for health secretary is chosen, vetted and confirmed.

“She’s a strong talent in her own right,” said Sara Rosenbaum, a health policy expert at George Washington University. “There’s every reason to believe that her skills and abilities will be of value to the White House regardless of who is secretary of health and human services.”

Health care advocates lamented Mr. Daschle’s departure. “This is a very real setback for the administration because Daschle has unique qualifications,” said Drew E. Altman, president of the Kaiser Family Foundation, which focuses on health policy. “His withdrawal might result in a loss of momentum, but I don’t think it’s a fatal blow.”

William A. Galston, a former policy adviser to President Bill Clinton who is now at the Brookings Institution, said Mr. Daschle combined political, policy and legislative experience. “I’ve been trying to wrack my brain to think of another person who could bring those three things together,” Mr. Galston said. “I’m not getting very far.”

Others played down Mr. Daschle’s importance, pointing to Mr. Obama’s commitment to the issue. “That’s not dependent on Tom Daschle or any one person other than Barack Obama,” said Richard J. Kirsch, the national campaign manager of Health Care for America Now, a grass-roots coalition.

Skeptics of Mr. Obama’s approach to health care were relieved. “We had some serious concern about Daschle’s desire to rush health care reform and push something through as quickly as possible,” said James P. Gelfand, senior manager of health policy at the United States Chamber of Commerce. “The administration could come up with a better consensus-builder.”

While the administration looks, Congressional Democrats may have more running room to shape a health care plan to their liking. Senator Max Baucus of Montana, chairman of the Finance Committee, and Senator Edward M. Kennedy of Massachusetts, chairman of the health committee, have been pushing forward on legislation for weeks.

“Max Baucus and Ted Kennedy put the gauntlet down even before the inauguration that they want to work with the president and his proposal but they weren’t just going to accept what they were given,” said Howard Paster, who was a Capitol Hill liaison for Mr. Clinton.

Mr. Baucus said Tuesday that he had spoken with Mr. Kennedy and planned to take up a health bill by summer. He dismissed the importance of the Daschle withdrawal. “It’s barely a little ripple in the water,” he said. “It’s not a wave, just a ripple.”

David M. Herszenhorn contributed reporting.

A version of this news analysis appears in print on , on page A16 of the New York edition with the headline: As Nominee Trips, Health Care Drive Suffers a Setback. Order Reprints|Today's Paper|Subscribe